in conversation with Dr Raghava Dutt Mulukutla, Orthopedic Surgeon and Chief of spine surgery
Q. Doctor I am suffering from back and leg pain and I am told that my vertebra has slipped forward.
A. You are suffering from a condition called spondylolisthesis. Here one of the vertebra slips forwards over the vertebra below.
Q. How does this happen?
A. There are a number of reasons for this. This could result from anomalies in the spine at birth, some in early childhood and some due to fractures and various diseases and conditions of spine.
The two most common varieties
1. the first variety, when the vertebra slips forwards between 4-6 years of age. This may cause back pain or leg pain during childhood or during adulthood. Sometimes due to extra weight of pregnancy, women come to doctors with back pain and this condition is then diagnosed
2. the second variety is one which is somewhat common in females at about the age of forty. This is due to degeneration (wear and tear) and is more common in women who are overweight.
Q. What are the treatment options for this condition
A. Most patients get better with physiotherapy and medication. Once the pain subsides it is important to start exercise programmes to strengthen back and abdominal muscle. Walking, sports, yoga, swimming all help.
Q. Do I require surgery?
A. Only if the pain does not subside with physiotherapy, restricted activity for a few weeks followed by exercises etc. Surgery is more beneficial in those who suffer from leg pain rather than back pain alone
Q. What is the type of surgery that is done?
A. In children and young adults sometimes repair of the defect in the vertebra .is done to prevent back pain.Mostly screws and rods are placed in the spine and the vertebra that has moved forwarded is brought back to its original position. Cages are also used to maintain the reduction and restore the height between the vertebrae. Fusion is routinely done .
Q. How long do I need to take rest? And what are the precautions to be taken after surgery
A. You will be out of bed 2nd or 3rd day after surgery. You need to stay in hospital for 4-5 days. You will be in ICU for a day. You will be given a brace to support your back for a few weeks.
Q. When can I get back to work?
A. You need 6 weeks time for light duties and 3 months for heavy work.
Q. Do I need to undergo lot of physiotherapy?
A. You hardly require any physio. A few months after surgery physios will teach you a set of exercises which are very easy to follow and can be done at home.
Q. How painful is the procedure?
A. The procedure is not that painful and you will be given adequate pain relief medication after surgery
Q. can I play games and sports after surgery?
A. Swimming, yoga ,sports are all beneficial. You will be told how to lift weights and also given a set of exercises to strengthen your back.
Q. Will surgery affect my married life?
A. Not at all . You can have a normal married life and women can have babies and undergo normal deliveries
X ray showing how L5 vertebra has moved forwards on S1vertebra
Complete reduction of forward displaced L5vertebra over S1 restoration of normal alignmnet of spine